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MRI overuse in low back pain

Issue 39 Synovium (Summer 2013)

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Following the above revelations a Canadian study on the appropriateness of requests for MRI scanning for low back pain (LBP)1 is interesting. 2000 referrals for MRI – 1000 for LBP and 1000 for headache, two of the commonest reasons for MRI requests – were examined by an expert panel for each problem and rated as inappropriate, an uncertain indication or appropriate. Only 44.3% of LBP requests were considered appropriate compared with 82.8% for headache; 27.2% were deemed of uncertain value (headache 8.2%) and 28.5% inappropriate (headache 9%). When the figures were analysed by referring clinician, family physicians performed the worst with only 33.9% of their LBP referrals considered appropriate. Referral decisions are always complex and subject to multiple influences but the contrast between the two clinical areas is striking and raises many questions.

An earlier study2 looking at GP access to MRI for knee problems found that the only significant benefit that the MRI report brought to managing a case was increased clinician confidence. So do GPs lack confidence in dealing with LBP without imaging? And will enhanced awareness of potential disc infection be a confidence booster? Or will we see more requests for MRI scanning looking for Modic change? Interesting times.

Finally, the Summer 2013 issue of Hands On3 will provide valuable advice for those wanting to know more about when – and when not – to use imaging for musculoskeletal problems in primary care. 

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